ANXIETY, ANGER, ABUSE AND TERMINAL ILLNESS

THE CLIENT WITH AN ANXIETY DISORDER


 A client brought to hospital emergency room by his brother. The client is perspiring profusely,breathing rapidly and complaining of dizziness and palpitations. Problem of a cardiovascular nature are ruled out. The client's diagnosis is tentatively listed as panic attack.

 1 The emergency room nurse observe that the client is hyperventilating, which of the following measures would be best to try first to ease the symptoms caused by hyperventilation.
 a.Have the client breath in to the paper bag.
 b.Instruct the client to put his head between his knee.
c.Give the client a low concentration of oxygen by nasal Cannula.
d.Tell the client to take several deep,slow breaths and exhale normally.

 (The correct answer is a,The best way to easy symptoms caused by hyperventilation is to have the client breath into a paper bag. Having the client put his head between knees,giving him low concentration oxygen and having him take deep breath, slow and exhale normally will not alleviate symptoms of hyperventilation).

2.Which of the following nursing action would be inappropriate  on the client's admission to the unit.
a.Support the client's attempts to discuss feelings.
b.Respect the client's personal space.
c.Reassure the client of his safety.
d.Confront the client's dysfunctional coping behavior.

(the correct answer is d, supporting the client in his attempt to discuss feeling,respecting personal space and reassuring him about his safety promote a therapeutic nurse and client relation shift and prevent escalation of anxiety. Confronting dysfunctional coping behaviors or defense mechanisms will most likely be viewed as a threat and will increase the anxiety.

3.The client often jumps when spoken to and complains of feeling uneasy.He says 'it's as though something bad is going to happen',Which of the following nursing action would at least will benefits to the client.
a.Being physically present.
b,Being technically comptent.
c.Conveying an optimistic verbalization.
d.Communicating some respectful attitude.

(the correct answer is c,making optimistic statements avoid the client feeling and offer little help when feeling uneasy. Being present, demonstrating competence and respecting how the client feels are helpful for an anxious client')

4. During a conversation with the client,the nurse observes the client shaking his leg and tapping his fingers on the table next to him, the best statement from the nurse is.
a.'I see that you are anxious,I will be back later when you are calmer'
b.'I noticed that your leg is shaking and you are taping your fingers on the table,how are you feeling now'
c.'I will get something for you to help feel less anxious'
d.'I know that you are feel anxious.Let us discuss something more pleasant'

(the correct answer is b, the nurse help the client to recognize that he feeling anxious by pointing out his behaviors to him. The nurse then attempt to help the client recognize his anxiety and describe his feeling to help him connect behaviors with feeling. Telling the client that she will be back later or will get something  to help feel less anxious and changing the subject are not helpful to the client. The client want to avoid or ignore his anxiety,which will not help to deal with his feelings).

5.The nursing diagnosis for the client is social Isolation related to served anxiety,as evidenced by withdrawal into his room. An appropriate long term goal related to this nursing diagnosis is that the client will
a.attend group meetings with a staff member by discharge.
b.initiate interactions with the nurse when feeling anxious.
c.express two adaptive method of coping with anxiety.
d.participate in milieu activities by discharge.

(the correct answer is d, an appropriate long term goal for the client who withdraws into his room because of severe anxiety is that the client will participate in milieu activities by discharge. Attending group with a staff member with short term goal related to the problem of Social Isolation. Initiating interactions with the nurse when anxious does not relate to social isolation and would be an appropriate outcome to be expected earlier during the client hospitalization. Expressing two adaptive method of coping with anxiety does not relate to the problem of social isolation but would be an appropriate outcome related to the nursing diagnosis Ineffective Individual Coping)

6.In working with the client with an anxiety disorder, the ultimate nursing goal is.
a.reduce the client anxiety to a manageable level.
b.help  the client decrease denial and avoidance about his feelings and link feeling with behaviors.
c.assist the client with the problem solving and developing adaptive coping behaviors.
d.use supportive confrontation when the client avoids painful issues.

(the correct answer is c, Problem solving and building adaptive coping behaviors to deal with anxiety is the nurse's ultimate goal when working with the client who has an anxiety disorder or an unmanageable anxiety level, Reducing the client anxiety to a manageable level,helping the client decrease denial and avoidance about feeling and linking behaviors with feeling are important goal that are more immediate and short term).

7.The client seldom experiences feeling of panic and has been participating in groups.He tells the nurse,'I still have problems falling asleep without tossing and turning' Of the following nursing actions,which be most helpful to the client.
a.teach him relaxation exercises.
b.tell him to ask his physician for medication.
c.recommend that he watch television until he get sleepy.
d.advise him ti ride the exercise bicycle for 10 minutes before retiring for the night.

(the correct answer is a, relaxation exercise will be most helpful because they provide the client with an adaptive mechanism to manage stress and produce a physiologic response opposite that anxiety. The relaxation response decrease pulse rate,blood pressure and respiration rate).

8.The client is taking alprazolam(Xanax) to treat moderate to severe anxiety. Xanax will help the client to.
a.focus less on somatic symptoms of anxiety.
b.deny problems with symptoms of anxiety.
c.avoid feelings of anxiety.
d.maintain hypersensitivity to stimuli.

(the correct answer is a, Xanax (Alprazolam) is a benzodiazepine used on a short time or temporary basis to treat psychology-cal and somatic symptoms of anxiety and as an adjunct to other treatments. Physical and psychology-cal dependence can occur as well as tolerance ).

9. While the client is taking Xanax he should be taught to avoid ingesting.
a.chocolate
b.cheese.
c.alcohol.
d.shellfish.

(the correct answer is c, using alcohol or any nervous system depressant when taking benzodiazepine is contraindicated because of additive effect).


The Nurse works at a community Mental Health Center.

10.The client with an Axis I diagnosis of post Traumatic Stress Disorders tells the nurse he wishes tha he had been on airplane that crashed and killed his wife and children a month ago. The nurse assesses  the client statement to be;
a.Suicidal Ideation.
b.Survivor guilt.
c.Dysfunctional Grieving.
d.Numbing of responsiveness.

(the correct answer is b, with post traumatic stress disorder ,the client experiences survivor guilt or feeling of guilt related to being alive. The client's statement does not indicate suicidal ideation. Dysfunctional grieving is inaccurate because the accident occurred just only one month ago. Numbing of responsiveness pertains ti having a restricted affect, a limitation in the range of feeling, a feeling of detachment from others and the external word and hopelessness or lack of expectations about the future).

11.The client stat.'You don't know what I have been through.what can you do', the best nurse answer is.
a.'I need to refer to a survivor's group where you will feel more comfortable'
b.'Perhaps you will feel better if you can become interested in hobby once again'
c.'I would like to help you if you let me'
d.'I haven't been through what you have,but be better able to understand if you tell me more about it'

(the correct answer is d, the nurse is nonjudgmental, is a supportive and conveys honesty and empathy to the client. Telling the client he will feel more comfortable in a survivor group dismisses the client. How ever a survivor group may be need later. Stating that the client should become interested in a hobby is not helpful. Stating ' I would like to help you if you let me', may alienate the client).

12.The client has been taking Buspirone (Buspar) for two days as prescribed, which one client statement indicate a need  for further teaching.
a.' I can take Buspar as I need when I am anxious'
b.' I may not feel better for Seven to Ten days'
c.'I can't become physically dependent Buspar'
d.'I need to take Buspar with food'

(the correct answer is a, Buspirone (Buspar) a nonbenzodiazepine anxiolytic, is not administered on an as needed as basis because it has a delayed onset of therapeutic action. Therapeutic affects may be experiences for Seven to Ten Days,with full effects not occurring for 3 or 4 weeks. This drug is not known  to cause physically or psychologically dependence).


A week ago a Tornado destroyed the client's house and seriously injury her husband. The client has been walking around hospital i a daze with out any outward  display of emotions.

13.The client has been admitted to the stress unit with the diagnosis of Acute Stress Disorder. The client tells the nurse in a matter of fact manner that her husband is paraplegic, 'but that better than total paralysis'. Which protective mechanism is the client exhibiting;
a.Suppression
b.Rationalization
c.Dental
d.Intellectualization

(the correct answer is d, the client is exhibiting Intellectualization, which is using logical explanation with out feeling or an affective component. Suppression is the voluntary exclusion from awareness of feelings, Ideas or situations that are anxiety provoking. Rationalization is an attempt to make or prove that one's feeling or behavior are justifiable. Denial is an unconscious refusal to admit a acceptable idea or behavior)

14.The client tells to the nurse,she feel she is going crazy, The nurse initially;
a.explain the effects of stress on the mind and body.
b.assures the client her feeling and behavior are typical reaction to serious trauma.
c.reassure the client that her symptoms are temporary.
d.acknowledges the unfairness of the client's situation.

(the correct answer is b, the nurse initially assure the client that her feeling and behavior are typical reaction to serious trauma to help decrease anxiety and maintain self-esteem. Explaining the effect of stress on the body may be helpful later. Telling the client that her symptoms are temporary is less helpful. Acknowledging the unfairness of the client situation does nothing to address, the client's needs at this time).

15.On discharge, the client is referred to the out patient clinic for follow-up. Which of the following hospital learned abilities is probably most important for the continued alleviation of anxiety symptoms ?, The client:
a.recognize when she is feeling anxious.
b.understand the reason for her anxiety .
c.can use methods to reduce anxiety.
d.can describe the situations preceding her feeling of anxiety.

(the correct answer is c, The client with anxiety may be able to learn to recognize when she is feeling anxious,understand the reason for her anxiety and be able to describe situation that preceded her feelings of anxiety . How ever,she is likely continue to experience symptoms unless she also learned to use her behaviors to reduce anxiety).